The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening

Placzek, Richard; Ruffer, M.; Deuretzbacher, G.; Heijens, E.; Meiss, L.

doi:10.1007/s00402-006-0142-5

Cited by 25 publications

(10 citation statements)

References 13 publications

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“…Pieske et al [25] , 2011 Pieske et al [26] , 2010 Placzek et al [16] Prospective nonrandomised comparative study . loosening (extraction torque < 150 Nmm per degree).…”

Section: Resultsmentioning

confidence: 99%

“…The defi nitions of pin loosening were extremely variable. Both Moroni et al [13] and Placzek et al [16] did not use a standardized definition of loosening. Placzek et al [16] used the fixation index which they developed to determine screw fixation strength.…”

Section: Discussionmentioning

confidence: 99%

“…Both Moroni et al [13] and Placzek et al [16] did not use a standardized definition of loosening. Placzek et al [16] used the fixation index which they developed to determine screw fixation strength. Pommer et al [28] used both clinical and radiological criteria to define loosening.…”

Section: Discussionmentioning

confidence: 99%

“…Hydroxyapatite is a crystalline molecule which constitutes 65% of the mineral component of human bone [15] . It has widely and effectively been used in orthopaedic surgery as a bone substitute and prosthetic coating [16] due to its osteoconductive [17] and osteoinductive properties [18] . Studies investigating the use of hydroxyapatite as a coating for external fixator pins have shown promising results in terms of fixation [13,19,20] .…”

Section: Clinical Benefit Of Hydroxyapatite-coated Versus Uncoated Exmentioning

confidence: 99%

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Clinical Benefit of Hydroxyapatite-Coated Versus Uncoated External Fixation: A Systematic Review

Patel

Ghai²,

Anand

2016

International Journal of Orthopaedics

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AIM: Common complications of external fixators include pinloosening, infection and loss of reduction/malunion. These are increased with prolonged fixation. The main aim of this systematic review was to investigate HA-coated versus uncoated external fixator and determine benefits in terms of pin loosening, infection and loss of reduction/malunion. MATERIAL AND METHODS: A systematic literature search using PubMed, EMBASE, OVID SP, Cochrane database, ClinicalTrials.gov website and the references of the studies identified was undertaken on 26th August 2014. Comparative trials investigating HA-coated versus uncoated external fixation pins were identified. These were limited using strict eligibility criteria and critically appraised as per the CASP and CONSORT guidelines. Primary outcome measures included pin loosening and infection. Secondary outcome measures included loss of reduction/malunion. RESULTS: Seven studies were identified of which five studies demonstrated a statistically significant reduction in loosening with HA-coated pins. There was insufficient evidence to demonstrate any clinical benefits, such as numbers needed to treat to avoid early removal of pins. Review of the studies included also demonstrated insufficient evidence to determine any significant clinical benefit with regards to infection and malunion. Critical appraisal demonstrated average methodological quality of the studies. CONCLUSION: HA-coating of external fixator pins improves bone fixation and reduces loosening in patients undergoing prolonged fixation procedures, such as leg-lengthening, but the influence on infection and malunion is not clear. Further large, well-designed randomised controlled trials with observer blinding, standardized pin insertion and pin care investigating clinically relevant pin loosening, infection and malunion are recommended. Patient reported, functional outcome measures should also be considered.

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“…Pieske et al [25] , 2011 Pieske et al [26] , 2010 Placzek et al [16] Prospective nonrandomised comparative study . loosening (extraction torque < 150 Nmm per degree).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Benefit Of Hydroxyapatite-coated Versus Uncoated Exmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Benefit of Hydroxyapatite-Coated Versus Uncoated External Fixation: A Systematic Review

Patel

Ghai²,

Anand

2016

International Journal of Orthopaedics

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“…The concept of applying a biocompatible and bioactive hydroxyapatite (HA) coating onto metallic implants as functional surface coating has been verified to be an effective way of improving the bone-pin interface strength [6][7][8]. Several animal and clinical studies con-firmed the osteoconductive properties of HA coatings resulting in enhanced stability at the pin-bone interface and hence reduced pin loosening [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Impact of Biomechanical Forces on Antibiotics Release Kinetics from Hydroxyapatite Coated Surgical Fixation Pins

Lilja¹,

Sørensen²,

Sörensen³

et al. 2013

JBNB

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This work investigates the impact of biomechanical wear and abrasion on the antibiotic release profiles of hydroxyapatite (HA) coated fixation pins during their insertion into synthetic bone. Stainless steel fixation pins are coated with crystalline TiO 2 by cathodic arc evaporation forming the bioactive layer for biomimetic deposition of Tobramycin containing HA. Tobramycin is either introduced by co-precipitation during HA formation or by adsorption-loading after HA deposition. The samples containing antibiotics are inserted into bone mimicking polyethylene foam after which the drug release is monitored using high performance liquid chromatography. This analysis shows that HA coating wear and delamination significantly decrease the amount of drug released during initial burst, but only marginally influence the sustained release period. Spalled coating fragments are found to remain within the synthetic bone material structure. The presence of HA within this structure supports the assumption that the local release of Tobramycin is not only expected to eliminate bacteria growth directly at the pin interface but as well at some distance from the implant. Furthermore, no negative effect of gamma sterilization could be observed on the drug release profile. Overall, the observed results demonstrate the feasibility of a multifunctional implant coating that is simultaneously able to locally deliver clinically relevant doses of antibiotics and an HA coating capable of promoting osteoconduction. This is a potentially promising step toward orthopaedic devices that combine good fixation with the ability to treat and prevent post-surgical infections.

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An Alternative Coating Technique To Strengthen Pin-Bone Interface Stresses For External Fracture Fixation: A Preliminary Study

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The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening

Abstract: HA coating resulted in improved fixation of Schanz screws in bone and may be useful in prolonged external fixation of the lower leg. The fixation index proved to be a simple tool for the evaluation of the fixation strength of Schanz screws.

Cited by 25 publications

References 13 publications

Clinical Benefit of Hydroxyapatite-Coated Versus Uncoated External Fixation: A Systematic Review

Clinical Benefit of Hydroxyapatite-Coated Versus Uncoated External Fixation: A Systematic Review

Impact of Biomechanical Forces on Antibiotics Release Kinetics from Hydroxyapatite Coated Surgical Fixation Pins

An Alternative Coating Technique To Strengthen Pin-Bone Interface Stresses For External Fracture Fixation: A Preliminary Study

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